Publication History

An 80-year-old man was admitted to the emergency department with fever, jaundice, and abdominal pain due to common bile duct (CBD) lithiasis. His past medical history revealed chronic renal failure and atrial fibrillation, which was treated with warfarin. Therapy with antibiotics and phytomenadione was promptly started, and international normalized ratio values returned to normal.

Cholangiography showed the CBD dilated up to 18 mm and multiple large stones. Sphincterotomy was performed, followed by papillary pneumatic dilation up to 15 mm and stone extraction, with no residual filling defect at cholangiography.

After 3 days, another episode of melena and anemia occurred. A further ERCP was performed, and showed a distally migrated biliary stent and visible oozing bleeding coming from the inside the CBD ([Fig. 3]).

The patient’s general condition and laboratory tests improved until discharge. There were no clinical signs of bleeding at 6-month follow-up.

This case describes the possible challenges in treating post-ERCP biliary bleeding and a new promising simple approach that should be considered as a part of the endoscopist’s armamentarium. To our knowledge this is the first described case of hemostatic APC application in CBD under direct visualization [1]
[2]
[3].

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.This section has its own submission website at https://mc.manuscriptcentral.com/e-videos